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Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the Cochrane Collaboration\u2019s ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS) were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> and <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> statistics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001). The pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (<jats:italic>p<\/jats:italic>\u2009=\u20090.001).\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications. However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be viewed with caution.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level III; systematic review and meta-analysis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00590-023-03492-3","type":"journal-article","created":{"date-parts":[[2023,2,25]],"date-time":"2023-02-25T20:02:17Z","timestamp":1677355337000},"page":"2831-2846","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical outcomes for grades III\u2013V acromioclavicular dislocations favor double-button fixation compared to clavicle hook plate fixation: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"33","author":[{"given":"Erik","family":"Hohmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Tetsworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,25]]},"reference":[{"issue":"2","key":"3492_CR1","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1177\/0363546506298022","volume":"35","author":"AD Mazzocca","year":"2007","unstructured":"Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular injuries. 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